Major Depressive Disorder

Residential Treatment of Major Depressive Disorder at CooperRiis

Residential treatment of major depression at CooperRiis begins when the resident arrives at CooperRiis and is treated with compassion by our caring staff and other residents. Depression almost always means isolation. When residents arrive, they step back into a socialized life. We are very gentle and help to ease the resident into life at CooperRiis. We work with individual residents to find what is most helpful for them, rather than imposing a hard agenda on them. In this way, residents are empowered to be an essential part of their own recovery team.

Soon after settling in, residents meet with their team, which includes a therapist, a recovery coordinator, and our psychiatrist. All residents take part in a full evaluation in which they give a history of their lives, symptoms, and illness. We want to get to know residents and develop a full picture of what is troubling them – low mood, trouble with motivation, disruption in sleep, decrease in planning, changes in appetite, etc. – as well as what treatments they have had in the past, and what medications were most helpful.

All residents meet with our Integrative Psychiatry Director to discuss how medications can contribute to their recovery. It is important that we know about the resident’s treatment experiences, both negative and positive, so that we can best prescribe an antidepressant.

Medication, Therapy, and Other Treatment Modalities

Medication for Major Depression Disorder

The medications used to treat Major Depressive Disorder are called antidepressants, and there are several antidepressants available. We work with the resident to find the best dosage to reduce symptoms without incurring harmful side effects such as over sedation, sexual side effects, and mental fogginess. The goal is to minimize symptoms without sacrificing overall well-being.

Supplements, such as nutraceuticals, vitamins, minerals and plant extracts, are also used as a part of the treatment. In some instances, the dosage of an antidepressant can be reduced because the supplements have such a positive effect on symptoms.

Getting the right medication at the best dosage is a huge concern, but it is only part of the treatment plan at CooperRiis. We find that a combination of medication, psychotherapy, exercise, community involvement, and other interventions is most effective in treating the whole person.

Psychotherapy for Major Depression Disorder

For treatment of any challenge, CooperRiis takes a holistic approach. We don’t focus on the diagnosis, we focus on helping. What can you do? What does sound good to you? How can we best help you? Some of the therapy modalities we find useful for treating depression are:

Motivational Interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. During Motivational Interviewing, the therapist asks questions and uses reflective listening skills. The resident drives the session and the therapist is listening for cues to go deeper. It’s a wonderful technique to get to the root of things without an agenda.

Acceptance and Commitment Therapy (ACT) is a form of mindfulness-based therapy that theorizes that greater well-being can be attained by overcoming negative thoughts and feelings. ACT looks at character traits and behaviors to assist in reducing avoidant coping styles. ACT also addresses commitment to making changes and sticking to goals.

Compassionate communication (also called nonviolent communication) teaches how to clearly communicate feelings without blame or criticism, as well as empathetically receiving/listening to how someone else is without hearing blame or criticism. It helps individuals understand their own needs and recognize that others’ needs may be different.

Group Therapy

Our group therapy sessions are about learning resilience by being in a group and learning to speak up. The groups are small and interactive and there is a lot of sharing and hearing other people’s stories, which encourages empathy and compassion. We find that this human experience can be incredibly helpful for those with depression. People begin to see that they are not broken, and that other people are having similar issues to their own. After being in group therapy for a while, residents begin to see themselves in a different light. Self-criticism begins to shift to the recognition that they are survivors and that they are not damaged. Not only do residents realize that they can emerge from depression, but that they can be a support for others as well.

Seven Domains of a Whole, Healthy Person

Physical wellness

Emotional and psychological health

Spirituality

Intellectual creativity and learning

Social and community connectedness

Purpose, productivity, and fulfillment

Empowerment and independence

Because every person is different, some domains will receive more emphasis than others, but all are attended to. A recent exciting addition to CooperRiis is our new Spiritual Director. This new staff member provides more opportunities for residents to go to church, celebrate holidays, participate in mindfulness exercises, yoga, and other spiritual pursuits. For people dealing with depression, connection to their faith or a higher power can be inspirational as well as provide hope.

What is Major Depressive Disorder?

Sadness is a part of life. Occasional feelings of melancholy, listlessness, or ‘the blues’ are just a few of the many feelings we experience as healthy individuals in response to our world. Clinical depression, however, is different, and is considered a serious mental health condition. A Major Depressive episode is defined by an incessant feeling of intense sadness and lack of interest in formerly enjoyable activities that goes on for an extended period. Major Depressive Disorder (MDD) impacts both mood and behavior. People with Major Depressive Disorder often have trouble performing and participating in everyday activities and sometimes feel as if life isn’t worth living.

Major Depression is surprisingly common. The Journal of the American Medical Association states that the lifetime incidence of depression in the United States is more than 20-26% for women and 8-12% for men.

The median age for the onset of clinical depression is 32 (U.S. Census Bureau Population Estimates by Demographic Characteristics, 2005).

Equine therapy…

Mind and Heart Together…

How sweet it is…

Summer day in the lake

Let there be sun

Fishing is a favorite passtime

Types of Depressive Disorder

Seasonal Affective Disorder (SAD) – depression directly caused by the time of the year. It occurs most often in the winter months when sunlight is not as readily available, typically going away in the spring and summer.

Persistent Depressive Disorder – depression that lasts for two years or longer.

‘Situational’ Depression – usually a short-term, stress-related type of depression that develops in response to a traumatic event. Common events that can trigger situational depression include the death of a loved one, divorce, and illness. Situational depression is also called ‘stress response syndrome’.

Signs and Symptoms of Depression

To be diagnosed with major depression, you must be suffering from five or more of the following symptoms for two weeks or longer, and at least one of the symptoms must be loss of interest in activities or a depressed mood. Symptoms may vary depending on what kind of depression has been diagnosed.

Feelings of sadness and/or irritability

Loss of interest in once enjoyable activities

Significant change in weight (loss or gain)

Changes in sleep patterns – trouble falling asleep, insomnia, or the need to sleep more than usual

Feeling and appearing restless and agitated or slowed down

Fatigue or loss of energy

Feelings of worthlessness and guilt

Inability to focus/difficulty in thinking

Thoughts of death or about suicide

(Adapted from DSMV)

Other symptoms that are commonly seen in depression but not part of the diagnostic criteria include negative thinking with an inability to see positive solutions, irritability/lashing out at loved ones, social isolation, and difficulty making decisions.

The Seven Domains Enhanced Recovery Model by Sharon Young, Ph.D.

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Creating art with Jim

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Our Campus

Balanced meal lunch

Building trust

Weekend outings are great fun

What’s cooking?

Community Enhancement Art Therapy

Thriving in a Supportive Residential Community

The skills learned in group therapy are applied naturally and casually in our community. Having kind, supportive people always around who are experiencing similar challenges is incredibly helpful to our residents. Our residents are truly immersed in a recovery culture where everyone is heard, understood, and never judged.

Within weeks of being a part of our community, residents begin smiling more and making eye contact. Residents have expressed that they feel like they can breathe a little easier because everyone is so supportive and encouraging. Although it seems simple, making friends and connecting with others is a huge part of recovery. When people feel connected to others they no longer feel isolated, one of the most devastating parts of depression.

This connection with people along with the soothing elements of our property, which include animals, a lake, trees, opportunities to work on the land, etc., is a great break for the nervous system. There are opportunities for quiet and contemplative space, as well as communal spaces to interact with others.

Along with living in a community, our residents learn how to work in community with others. Residents spend about half their day at CooperRiis on a work crew. The work crews provide structure and purpose. Residents receives guidance and support from other people while developing transferable skills that they will be able to use for the rest of their lives. There are several crews — kitchen, garden, wood shop, animal, greenhouse, and art crews — all of which contribute to our community.

CooperRiis recognizes that people are not their diagnoses and that recovery is a multifaceted journey unique to each person. True recovery and eventual thriving involve far more than a one-size-fits-all prescription. That is why CooperRiis addresses every single facet of our residents’ lives.

Family Education and Support

Residents’ families are an essential part of their treatment team at CooperRiis, and we truly enjoy working with families. People with depression need a stable support system to continue to live a full, healthy life once they reintegrate into the world. To support the resident’s recovery, we strive to strengthen the entire family unit. Family support of someone with mental illness can reduce the rate of re-hospitalization by up to 75 percent over a three-year period (SAMHSA). Strong families help support strong recoveries.

Although we strongly encourage family participation, the resident guides and informs our communication with family members. We encourage our residents to reach out to their families in healthy and beneficial ways. Ideally, the resident and family participate together in recovery, and everyone benefits.

Is Treatment for Major Depressive Disorder at CooperRiis Effective?

The CooperRiis model of recovery works. CooperRiis’ clinical services and therapeutic community approach is supported by an extensive body of research and clinical experience. Data collected during a ten-year study shows individual recovery progress within the CooperRiis residential program based upon therapeutic community principles and a Seven Domains Enhanced Recovery Model (Young, Schactman and Snyder, 2014).

Results demonstrate recovery progress on many different domains of wellness in addition to symptom reduction, including gains in functioning, emotional well-being, sense of purpose, and hopefulness. Over 80 percent of our residents pursue employment, volunteer service or school while in our community programs, and increasingly manage independent living.

Our program helps residents achieve their best life by tailoring our services to their needs. We honor each person’s recovery journey by trusting them to work with us toward their best state of health and happiness.

About the Author

Michael Groat, MSc, PhD is President and CEO of CooperRiis residential treatment program located in Asheville and Mill Spring, North Carolina. Michael earned his Ph.D. in Counseling Psychology from SUNY-Albany. Prior to joining CooperRiis, he was associate professor of psychiatry and behavioral sciences at the Baylor College of Medicine, Houston, TX, where he also served as director of the division of adult services at the Menninger Clinic.

Michael is also a former candidate in adult psychoanalysis at the Center for Psychoanalytic Studies, Houston, and completed a 4-year fellowship in psychodynamic psychotherapy at the Austen Riggs Center. He has published on suicide prevention, applications of attachment research, and uses of clinical outcomes, and has lectured nationally and internationally on the same. Michael has long-standing interest in suicide prevention, therapeutic communities, organizational and systemic interventions, personality assessment, and intensive psychotherapy.

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